DHVI Flow Cytometry Facility Hazard Assessment Form

Flow Facility HA Form
End User Name

First NameLast Name
End User E-mail
End User Phone

Area CodePhone Number
Lab PI Name

First NameLast Name
Are you linked to your PI and a Fund code in CoreResearch?

FACS: Hazard Assessment
Please provide details regarding potential biohazards in your samples so we can safely process them.
Do your samples come from a source deliberately treated with an infectious agent?
Please list the infectious agent(s):
Do your samples come from a source that incorporated recombinant DNA and/or Viral Vectors?
Briefly describe the rDNA/vector used:
IBC Registration Number:
IBC Registration Title:
Should be Empty: